The National Rifle Association and other gun rights groups had pushed for a much stronger bill that would have precluded doctors, in many cases, from asking patients about whether they own guns. Backers of the measure, sponsored by Sen. Greg Evers, R-Baker, had said patients were being harassed over gun ownership.

But citing the confidentiality of what is said between doctors and patients, and a broader desire to protect other members of patients’ families, doctors had pushed back hard against the bill (SB 432). The issue had promised a fight between two of the most powerful lobbies at the Florida Capitol.

But an amendment adopted before the committee’s vote on Monday would now generally allow doctors to ask questions about gun ownership, as long as the physician doesn’t “harass” the patient, and doesn’t enter the information into the patient’s record without a good reason. That leaves enough room that doctors now support the measure, as does the NRA.

Nobody should support this bill. I’ve said so before. And to remind everyone, I’m a doctor who owns a gun.

Your doctor harasses you about guns? Stand up, walk out, get another doctor. Tell your shooting friends to avoid that doc. That’s fine. Look, if you own a gun, ostensibly for self defense, but cannot say ‘no’ to a question you think is out of bounds you need to sell your gun. Use the money to buy a sign that says “Please don’t hurt me, I’m unarmed (and don’t ask me questions in an offensive manner either)”.

What kind of sissies live in Florida that if their doctor ‘harasses’ them about guns they need a law affecting all doctors in their state so they don’t have to say ‘none of ya beezwax’? Really, this rose to the level of insult to the patient population that legislation was required? This is where our Republic is, we need to regulate speech so nobody gets offended?

Nothing good will come of this special interest encroachment into what can be discussed in a physician patient relationship. This sets a terrible precedent going forward. ‘Well, it was okay to ban conversations about guns, so now the (insert special interest group) manufacturers have this bill, see, and…’.

Shame on the Florida docs for agreeing to this travesty. Opposing this, and taking it to court had it passed, would have been the right thing to do. For your profession, your patients, and your country.

Comments

I agree, this is not a question doctors really need to know the answer to, and I am a multiple gun owning doctor as well. The only exception might be a pediatrician who would ask it as part of a standard safety screening ie have gun? have trigger locks?, etc. I think we should not prevent them from asking these types of questions, or ourselves in the ER either if we are filling the pediatrician role.

There are other situations in which it might be appropriate to ask about gun ownership–for example, when a young man from a gang-filled neighborhood is brought into the ER with a knife or gunshot wound, since experience has shown that the likelihood of his seeking revenge afterward is high, and intervention at that point can sometimes forestall a revenge murder. Another example: victim of domestic violence in the ER, as part of the assessment of how dangerous the home situation might be.

But the decision to ask patients about gun ownership should be based on the physician’s judgment about the patient’s health and safety, not some ridiculous law that proscribes certain speech. This is as stupid and infuriating as laws that attempt to prescribe certain speech, like showing prenatal videos to women seeking abortions. I suspect the people looking to tell doctors what they must and must not say to their patients are often the very same people complaining that the health care bill allows the government to intrude on their relationship with their doctor.

The doctor has absolutely no business asking this because the doctor has absolutely no authority to do anything about the information the thus gains.

So what if it is a DV case? What can the doctor do? He is not law enforcement. So what if it is a gang member? Isn’t his gang membership demonstrably more dangerous than the risk he will tak revenge at some future time? Again, what cant he doctor do about it? He can’t go to the gang member’s home and remove the gun. He can’t even ask the police to do that.

Likewise for asking children this question. The doctor does not need to know. It is intrusive and its only purpose is to support nanny-state anti-gun laws.

I do not use gun locks at all. I have kids in my home. My kids are at less risk from my guns than from my garbage disposal. I don’t see any pediatricians asking about that.

Doctors: Treat diseases and injuries. Stay out of the social change lane. That is not why we pay you.

Boy, doctors are sissies. Here, they have a state protected monopoly on practicing medicine, and they don’t like it when the state presumes to tell them how they can practice.

Hey, if you’re a doctor, and you don’t like this law, move your practice to a state where they don’t have such a law. If all the states have such laws, move your practice to a country where they don’t have such laws. What? You say that’s an onerous burden?

No, it’s not. It’s no more of a burden than telling someone who lives in a small town where there’s ONE doctor that if he doesn’t like the questions, he should get up and find another doctor.

Drug, gang violence, maybe. Kids for sure. Professor Hale, I have no trigger locks either, but that is a standard safety question that can be found in many pediatric text books right there with car seats, toxic materials in home, etc. It is just to allow parents to think about safety, there is no law that says they have to have the locks, and we wouldn’t pursue it any further. Doctors are in a unique place at the crossroads between science and hunanities, and we have alsways been directly in the “social change lane.” See Howard Dean, Rand Paul, Ron Paul, Jean Paul Marat, Bill Frist, Che Guevera, Anton Chekov, Arthur Conan Doyle, W. Somerset Maugham, William Carlos Williams, Oliver Wendall Holmes, James Mchenry (US Constituition signer), among many, many others. We are an integral part of social change. Like I said, I own multiple guns, and they would have to pry them from my cold dead hands to get them, but we are not talking about gun control here.

Professor Hale,
just so I understand, you’re totally onboard with the Florida Legislature restricting speech? Because that’s what you’re supporting here.

Asking about guns in the home isn’t about social change (it might be for less than 1% of pediatricians) it’s about professional counseling for home safety.

Docs can’t do anything with the information? Agreed, they’re not going to bolt out of the exam room and help you get a safe for your weapons, but they will do what professionals do, counsel on safe gun storage and ownership.

To assume your straw argument and take it further, docs don’t cook for their patients, so why ask about diet, exercise, etc? Docs aren’t chauffeurs for any but their own kids, why would they ask about car seats?

It’s interesting that in a small but powerful set of folks attaching the word ‘gun’ to legislation suppresses rationality. As his going to happen here, the suppression of free speech rights.

The family practice we used to see started to ask once, then the nurse stopped and said that we didn’t have kids in the house, so it was obviously not applicable.

The only time it came up with our internist was when I was having hand problems that were related to repetitive strain. He had a list of items that could be responsible, and target shooting with handguns was high on the list of possbilities. Other than that, his position was that I am an adult and am capable of understanding potential risks related to the activities I participate in.

Of course, there is the surgeon we know who asks because he wants to know what “toys” we’ve bought lately and when we want to go shooting with him!

GruntDoc, you know as well as I do that this isn’t about doctors asking adult patients. It is about pediatricians–who already endorse banning all guns–asking small children if their parents own guns, and then using that information to set up a personal database. When all medical records become government property, this will constitute a gun database that can be used for purposes of confiscation.

Frankly, I doubt if they’ll even wait that long; I suspect that most of these “doctors” are e-mailing the information to the ATF as soon as the kid is out the door.

A little paranoia is healthy; ‘pediatricians grill tykes about guns and then call the ATF on them’ is several bubbles off level. Not provably correct, in fact. Yeah, I’ll bet ATF is just salivating to get those pediatricians records and dig out one data point among hundreds. Geez.

(You don’t sign in at your range, do you? There’s a much higher-yield, and easier to get list of gun owners, but I’m sure you thought of that).

Are there docs who want guns banned? Sure. If they let their personal beliefs get in the way of good patient care, well, shame on them. Call the County Medical Society and gripe, call the state and file a grievance. Do not think that banning speech about your pet paranoia is a) a good idea, b) going to have the result you want, and c) is in any way consonant with the First Amendment to the Constitution (it’s there above the Second, which you revere but doesn’t stand in isolation).

My own College has ventured into Teh Stoopid with support of a large magazine ban. Okay, and I could care less except that it makes my college look Stoopid. That’s the sum total of its effect. (In fact, I have increased the number of HiCap mags in my inventory since they made that statement, showing its powerful and lasting effect of practitioners of the College).

In case you wondered, here’s what the AAP actually has to say about this proposed legislation: AAP News Room. Looks to me like that have a cogent argument as to why they should ask, and then give professional guidance.

GruntDoc,
You seem like a reasonable guy so I will attempt to give you a reasonable response.

1. I don’t care about laws in Florida. That is for Floridians to decide. It is my understanding that the common understanding of the law is that there is an expectation of privacy in the dr’s office that would make the Florida law troublesome to enforce and likely to be overturned on appeal. I cannot predict how the courts will decide when the billpayer is the government (state or federal) and has an inherent right to supervise the administration of benefits and costs.

2. As a data analyst, I know that no one asks an empty question. There is a reason why the questions are asked. The answers to those questions go somewhere and someone uses them for something. Likely people at NIH will use it for statistical research to produce a report about how homes with guns are x% more likely to kill their own children than those that do not. This official government statistic will then be used as a basis for other laws to prevent homes with children from having guns or some other such punitive provision to “make things better”.

3. When a doctor asks me that question, I know that he is more interested in political causes than my health and safety. How do I know? Ho doesn’t ask me is I drive too fast or wear a bicycle helmet. He doesn’t ask me if I use recreational drugs or visit prostitutes. He doesn’t ask me about my illegal activities that would bring me into contact with dangerous people. In fact, there are a whole bunch of things that doctors don’t ask that are statitictally more likely to affect my health than gun ownership. But he skips over all that and goes right to the guns after my smoking and drinking.

4. It would be a simple matter for me to lie to him or simply not answer the question. But I really don’t want that kind of relationship with my doctor. Doctors get really thin skinned when the patient uses their own judgement abouth what is important and what is not. If I assume that most doctors are not just qualified by indeed really smart and motivated to help me, then it would be self defeating to have to withhold informaiton from him because I could not trust what he was going to do with that information.

5. With the advent of Obamacare, it is a given that previously held norms of medical records privacy are a thing of the past. While I expect the largest abuser will be the government itself, I understand how other people might fear loss of coverage or higher rates by private insurers due to the answers they give about their behaviors and gun ownership. The trend in this direction is a reasonable fear, not paranoia. When all medical records were locally kept, this was not a problem, but with new digital records standards, the game has changed.

6. You are correct when you note that using the word “gun” in legislation makes people foam at the mouth. There is a very good reason for that. It has become a reliable litmus test for the destruction of personal liberties.

7. While finding another doctor is a simple thing today, I fully expect it will get harder. Reports I have seen are showing a large shortage of doctors in many areas and that shortage is increasing. Further, my insurer (TRICARE) is the US government who already pays a reimbursement rate far below the market rate. So doctors are choosing to not accept people like me. Eventually, I can expect to have universal coverage but zero access. I will have a lot of company.

Professor Hale,
Thank you for the considerate comment. I’m going to reproduce some of your original comment below in italics, with my response following. (For readers who want to read his comment in full, without my ellipses and exclusions, see the one directly above).

1. I don’t care about laws in Florida. That is for Floridians to decide. It is my understanding that the common understanding of the law is that there is an expectation of privacy in the dr’s office that would make the Florida law troublesome to enforce and likely to be overturned on appeal. …
We should ALL worry when an elected legislature decides restricting one groups’ constitutional rights is fair play, no matter the supposed grievance. Because the right you lose isn’t coming back, then you have no leg to stand on when they come for the ones you thought were worth trashing. Picking and Choosing in the Bill of Rights will not bring a good result.

3. When a doctor asks me that question, I know that he is more interested in political causes than my health and safety. How do I know? Ho doesn’t ask me is I drive too fast or wear a bicycle helmet. He doesn’t ask me if I use recreational drugs or visit prostitutes. He doesn’t ask me about my illegal activities that would bring me into contact with dangerous people. In fact, there are a whole bunch of things that doctors don’t ask that are statitictally more likely to affect my health than gun ownership. But he skips over all that and goes right to the guns after my smoking and drinking.
I’m not an office based doc, so I cannot speak to that practice. It is true that guns are demonized in (some) physician circles, and I could tell you about range outings with several others. I don’t know why your doctor doesn’t ask you the other questions, but to assign malign intent indicates a paranoia about the question, and questioner, that’s just not in evidence.

4. It would be a simple matter for me to lie to him or simply not answer the question. But I really don’t want that kind of relationship with my doctor. Doctors get really thin skinned when the patient uses their own judgement abouth what is important and what is not. [True-GD] If I assume that most doctors are not just qualified by indeed really smart and motivated to help me, then it would be self defeating to have to withhold informaiton from him because I could not trust what he was going to do with that information.
I’ll leave it to you to square this argument with your #3. They are at odds, and #4 sounds like you’re using your intellect while #3 sounds much more fear-based. I don’t have to tell you which I think makes more sense.
And, you have to see them to appreciate the panoply of goofy formats of Medical Records; trust me it’d be a Really Low Yield to dredge medical records to find gun owners. Also, not worth the effort as the Feds have paperwork on every gun sold (legally in a shop, which is where I buy all mine) for decades, and every range I’ve ever been to has a sign-in sheet. Super Low Yield=not worth the effort if higher-yield sources exist.

5. With the advent of Obamacare, it is a given that previously held norms of medical records privacy are a thing of the past. While I expect the largest abuser will be the government itself, I understand how other people might fear loss of coverage or higher rates by private insurers due to the answers they give about their behaviors and gun ownership. The trend in this direction is a reasonable fear, not paranoia. When all medical records were locally kept, this was not a problem, but with new digital records standards, the game has changed.
The answer to this is very easy, and doesn’t involve suppression of free speech: forbid insurers to maintain any such list. Period. That’s not speech being infringed upon, and absent that data point your concerns about records can be allayed.

6. You are correct when you note that using the word “gun” in legislation makes people foam at the mouth. There is a very good reason for that. It has become a reliable litmus test for the destruction of personal liberties.
I’ll concede you have a preferred civil liberty, and I’d point out that suppressing speech is the trampling of a civil liberty you use, and need as much as the 2nd Amendment. If you think only the Second Amendment needs protecting I’d ask you think again about what you’ll be losing.

As the punchline of the old joke goes, if I have one of these, I can get all of those I want.

I am glad we can have this discussion. You seem to be drawing this as a line between first and second ammendment rights as if I can only choose one. Both amendments are intended to pretect the liberty of the individual against the actions of the Government. Therein lies the problem and the solution.

When health care providers are exercising “guidance” from the NIH or other government agencies and government agencies are paying the bills, I have to wonder whose side the doctor is on. Under a single payer scheme, the doctor is nothing more than a government employee (perhaps contracted). As such his asking such a question is detrimental to my liberties. As long as it is just a private relationship between doctor and patient, then no harm or foul.

I also have legitimate fears about the infringement of my freedom of speech but I don’t see this issue in that light. It is very similar to the policy that pregnancy counseling services were not permitted to advocate abortions. Abortionists called it a “gag rule” that infringed their freedom of speech. But in fact, it was just a limitation of the speech they could perform with government funding. Private counselors without government funding were always free to promote abortion. As more and more patients get their bills paid for by the government and subscribe to government rules, there will be more power to the government and less to the people. Nor will it be limited to gun ownership.

For instance: Bloomburg’s crusade against salt and transfats and everything ever written by Center for Science in the Public Interest.

It starts as advocacy. Then It becomes a law.

I have been around a lot of guns. Unless I arrive at the hospital with a gunshot wound, I see no medically relevant reason for my doctor to ask about gun ownership.

I agree that the gun ownerhip siezure angle is pretty low risk. But I don’t agree that gun ownership = higher insurance rates is low risk. We have already seen this progression with cigarettes. We are seeing this with Fat people. And we are seeing this so-called “healthy eating” campaigns.

Professor Hale,
you misunderstand my argument. I’m not advocating one over the other (1st v 2nd), I’m saying (I thought explicitly) that they’re co-equal, like the others, and throwing speech under the bus in support of gun rights (or any other special interest, and there are a lot waiting behind this one) is always the wrong answer.

I share your concerns about one version of the future, where docs are either explicit or defacto employees of the government. However, making laws based on what MIGHT happen is a false choice, especially if rights are infringed on the way to the potential future that isn’t yet.

I will say I don’t get your concern about private insurance and gun lists. AFAIK, none of the insurers are doing this. Why? Guns are an alternate Third Rail in politics, and the people who run them aren’t stupid. Greedy, awful, immoral maybe, but not stupid. Any such effort would result in such a national legislative outcome that would scare small children at 50 paces.

Comparison to guns and insurance with obesity/smoking and insurance ignores actuarial data, and nobody knows what your risks mean more than an Actuarial. It’s What They Do. Obesity and smoking risks are real, affect health care utilization and lifespan – shocker, insurance companies are interested in statuses that cost more than others. If there’s an association between gun ownership and increased healthcare expenditures, I’d be interested to know it. (So would you).

This doesn’t excuse the Nanny State, and here’s the Kicker: the same suppression of speech advanced in this bill is the Nanny State. Yes! It’s the State assuming it knows better than the individual and the trampling of Rights is the small cost of Doing the Right Thing, even if it’s the Bill of Rights that are trampled.

Small, situational arguments aren’t compelling when it’s the big ideas of our country at stake. Let’s not diminish ourselves by playing along with them.

However, making laws based on what MIGHT happen is a false choice, especially if rights are infringed on the way to the potential future that isn’t yet.

I think the real rub of your disagreement (with Professor Hale) is here.

With ObamaCare on the books, the only “MIGHT happen” is whether ObamaCare is implemented – single-payer is the logical and completely expected result (with government both in charge of payment rates AND owning the printing press, the government can simply operate at a loss until the private insurers are all driven out of the market – it is difficult to imagine this power going unused for long… one “bad” election would put this power in the hands of someone eager to use it).

As such, I feel pulled in Professor Hale’s direction, as I see such efforts and infringements (which I agree they are) not as a paranoid response to what “MIGHT happen” but as a direct response to what has ALREADY happened.

There’s nothing in the Florida reporting on this legislation that cites your concerns as being its motivation. It specifically cites ‘a couple of episodes of doctors harassing patients over gun ownership’. Nothing about ‘backdoor gun registration’ (neither of you said that, but it’s implied in your argument).

I’ve been asked once, by a nurse during a clinic visit, whether or not I had guns in the house. I asked her why she was asking, and she pointed to the space on the form of my health insurance/provider. My answer? “Hell, yes I own guns. You ever go through my neighborhood? You’d be a damned fool not to own at least one firearm, and keep it at arms reach in your bedroom”.

It is NOT about “protecting the children”, as others have noted. It’s simply another ratcheting-up of the anti-civil-rights groups that are running our governments. The nanny-state idiots who want complete government control over every aspect of our lives. This kind of thing is to once again turn the exercisers of a constitutionally-guaranteed civil right into social pariahs.

The solution is NOT to stifle free speech on anyone’s part. From what I’ve read of it, this bill is fairly stupid. The solution is to confront it head-on, while it’s still small, and for every person to stand up for themselves. I don’t feel threatened because some insurance company might give their records to the fed-dot-gov; heck, I’m on so many lists already it doesn’t matter. NICS, 4473’s, shooting club memberships, ammo purchases. They know where I live.

I was once asked by a nurse (apparently concerned I might have been a male victim of domestic violence) if I ever felt threatened in my home. I said, “Hell, yes. Just last week our neighbor’s house was broken into…they happpened not to be home at the time, but I think the burglars would have kicked their door in anyway. That’s why my wife and I both have carry permits.” She was somewhat taken aback, to say the least.

But even better is the approach to ask them what kind of professional training they’ve had in self-defense and home-defense counseling. Then (if they even answer that question), to ask them if their malpractice insurance company is aware that they are offering self-defense and home-defense counseling despite having never had any training. Then ask if their malpractice insurer will cover them in the event of something bad happening as a result of their misguided, un-professional counseling.

Gruntdoc,
My final word on this is that I actually agree with you on the defense of the first amendment. The wording of the law, whould be to restrict the bahavior of the government, not of doctors and nurses in a private practice.

The unresolved issue is how to restrict the behaviors of an organization that is acting like a government, the APA, without doing harm to invididual liberties.

Like I said, I have seen the pattern on this before. With cigarettes, the restrictions started with elevators, then airplanes, then public buildings, bars restaurants. Now you can be accused of child abuse if you smoke in the same care as your child. I am not defending cigarettes. I hate them and think they should be banned outright since it is not possible to enjoy them privately. But the pattern from gathering medical statistics to support advocacy and then demonizing and finally creeping levels of legislation is unmistakable, even at this early stage. It needs to be opposed now while opposition is still possible and before the majority of Americans starts to believe that no rational adult would own guns.

Hey relax. I am an FP in rural Illinois. I personally don’t own a gun but about 80% of my patients probably do, including the pediatric patients. My 10 year olds classmates have been hunting since 2nd grade. I don’t routinely ask about guns in my social history but I do when it is pertinent. And I should. And I should be able to. And my gun owning patients and their families appreciate it. I don’t have an agenda except their well-being and they know it. If they thought I did they would go to the doc in the next town over. Case in point, I asked the son and daughter of a farmer who has dementia that has been getting progressively worse but is still at home with his wife on the farm and support services if their dad had any firearms and suggested that now was the time to remove them. They were extremely grateful. They hadn’t thought of his rifle because they were preoccupied with taking his car away. In another recent case a 50 year old patient came in distraught because his 21 year old son had attempted suicide at college and he brought him home. I definitely asked if they had guns at home as well as any controlled substances or TCAs. He had already removed his firearms but not his wife’s meds. I suggested a med safe. He was grateful. Silliness like this shackles my ability to use common sense to solve problems but respect my patients.

Oh and @Professor Hale I ask some one in my rural town of a 1000 people whether they visit prostitutes or have anal receptive sex about as often as I ask about gun ownership. It’s all relative to the situation. I don’t necessarily put everything said to me down on paper (no need for your butt plug use or college recreational marijuana use to be disclosed to the life insurance company you apply to next year) but telling me the truth helps me treat the problem you have today. And people are astonishingly honest when you approach them this way. Oh and yes I totally agree that patients are consumers but it is hard to ignore that (at least in many states) many docs have practices that are at least 40-50% medicare and medicaid and more so any one who thinks the healthcare isn’t mostly government funded already is practicing in nirvana or ignoring basic facts. Private insurers take their cues from CMS already.

Professor Hale, the wording of the law does restrict the behavior of doctors and nurses in a private practice. The medical record is where I note my thought processes about a patient’s care. (I’m one of the dinosaurs that actually makes my note a narrative rather than using computer-generated templates.) The main reason I do this is to enable me to better remember the person and their situation the next time they are sitting in front of me, which is often 1-2 years later.) The Florida law would tell me that I can ask a question, but can’t put the answer in my note. As far as I’m concerned, my First Amendment rights have just been trashed, not just the government’s.

I also don’t see how the APA is “acting like the government,” but that’s for another post.